# A 35-year-old gravida 4, para 3 client at 36 weeks gestation is admitted with bright red vaginal bleeding and confirmed complete placenta previa. Which nursing action should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542944  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A 35-year-old gravida 4, para 3 client at 36 weeks gestation is admitted with bright red vaginal bleeding and confirmed complete placenta previa. Which nursing action should be the priority?

## 보기

1. Prepare the client for immediate cesarean delivery
2. Insert two large-bore IV catheters and obtain blood for type and crossmatch **✔ 정답**
3. Position the client in Trendelenburg position to reduce bleeding
4. Perform a sterile vaginal examination to assess cervical dilation

**정답: 2**

## 해설

With stable vital signs and fetal heart rate, priority is IV access and blood preparation for potential hemorrhage, not immediate delivery. Other options (Trendelenburg, vaginal exam) are contraindicated.

## 심화 해설

Clinical Judgment
This question evaluates RECOGNIZE CUES and PRIORITIZATION. The key cue is "34 weeks, painless bright red vaginal bleeding, complete placenta previa". This means the placenta completely covers the cervix, making vaginal delivery impossible, and the continuous bleeding is a life-threatening situation for both mother and fetus. The priority is to remove the source of the bleeding, which is immediate cesarean delivery. At 34 weeks gestation, the fetus is viable, and the risk from continuous bleeding outweighs the risk of preterm complications.

Memory Tip: The key keywords for placenta previa are "**P**ainless" and "**P**revia". It is characterized by painless bleeding, and a **V**aginal **E**xam is an **A**bsolute **C**ontraindication.

KR vs US: In Korea, when placenta previa is diagnosed, conservative treatment may be attempted depending on gestational age and bleeding amount, such as strict bed rest in the hospital and medication (tocolysis, steroids) to promote fetal lung maturity and delay delivery. However, in NGN/US exams, when there is active bleeding, immediate cesarean delivery is presented as the standard priority nursing intervention rather than conservative treatment.

## 임상 시나리오

Clinical Practice Guide
The core principles of managing placenta previa are to avoid triggering bleeding, stabilize the maternal condition, and deliver safely at the appropriate time.
1.  Absolute contraindications: Digital vaginal exam, use of vaginal ultrasound probe, sexual intercourse.
2.  In case of active bleeding: Immediate preparation for cesarean section is the top priority.
3.  In case of inactive/minimal bleeding: Hospitalization, strict bed rest, fetal monitoring, steroid administration (to promote lung maturity), and preparation of blood products may be carried out.

Caution: In SATA (Select All That Apply) questions asking "nursing interventions needed for a patient with placenta previa," "performing a vaginal exam" is never included. "Trendelenburg position" is also generally avoided as it can impair uteroplacental perfusion and cause respiratory difficulty. Instead, place the patient in the left lateral position.

## 핵심 개념

- **Placenta Previa (전치태반)** — The placenta is attached to the lower part of the uterus, partially or completely covering the internal cervical os. Painless, bright red vaginal bleeding is the characteristic symptom.
- **Complete Placenta Previa (완전 전치태반)** — The placenta completely covers the internal cervical os. Vaginal delivery is impossible, so a cesarean section is mandatory.
- **Cesarean Delivery (제왕절개 분만)** — Surgery to deliver the fetus by incising the abdomen and uterus. It is performed in various obstetric situations such as placenta previa, fetal distress, and umbilical cord prolapse.
- **Type and Crossmatch (혈액형 검사 및 교차시험)** — This is the process of checking the patient's blood type (ABO, Rh) for transfusion and testing compatibility with the donor's blood. It is essential to prepare this when massive bleeding is anticipated.
- **Trendelenburg Position (트렌델렌부르그 체위)** — A position where the patient's head is lower than the trunk and the lower extremities are elevated. Historically used in shock, but currently not recommended in many cases due to negative effects on the respiratory system.

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